Provider Demographics
NPI:1073715694
Name:LOZADA, ANGELA M
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:LOZADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 13 BLOQUE R33
Mailing Address - Street 2:ALTURAS DE INTERAMERICANA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-0000
Mailing Address - Country:US
Mailing Address - Phone:787-619-5768
Mailing Address - Fax:
Practice Address - Street 1:AVE MUNOZ MARIN, URBANIZACION VILLA CRIOLLO
Practice Address - Street 2:A29
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-0000
Practice Address - Country:US
Practice Address - Phone:787-746-0100
Practice Address - Fax:787-746-0100
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3464103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3464OtherLICENCIA